Definitive risk factors for anastomotic leaks in elective open colorectal resection
Definitive risk factors for anastomotic leaks in elective open colorectal resection
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DOI：
10.1001/archsurg.143.9.907
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发表时间：
2008-09-01
影响因子：
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通讯作者：
Wilson, Samuel Eric
中科院分区：
文献类型：
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作者：
Suding, Paul;Jensen, Erin;Wilson, Samuel Eric
假设：择期结直肠切除术后吻合口漏增加了发病率、死亡率和额外干预的需要。对危险因素的准确了解可能会减少吻合口漏和/或允许适当地选择患者进行分流。设计：对导致吻合口漏的患者和手术特点进行前瞻性回顾。地点：美国境内的51个地点(2002年5月至2005年3月)。患者：672名患者参加了一项在择期开放结直肠手术中比较术前抗菌药物的试验。主要观察指标：根据临床结果诊断吻合口漏并经成像证实。在单因素和多因素分析中，我们检查了可能影响吻合口愈合的20个变量。结果：在672例(3.6%)接受择期结直肠切除术的患者中，有24例吻合口漏。死亡10例(1.5%)。在单变量和多变量分析中，基线白蛋白水平低于3.5g/dL(换算为克/升，乘以10)(P=0.04)和男性(P=0.03)与吻合口漏相关(调整后的优势比分别为2.56和3.12)。在单因素分析中，手术时间(SD，60分钟；优势比，1.53；95%可信区间，1.06-2.22；P=0.03)和手术时使用类固醇(优势比，3.85；95%可信区间，1.24-11.93；P=0.02)的增加是显著的。直肠切除手术、厄他培南预防(vs头孢替坦)、肥胖、吸烟或糖尿病病史与吻合口漏无关。结论：术前血清白蛋白水平低、使用类固醇、男性和延长手术时间是吻合口漏的重要危险因素。对风险因素的认识为临时分流提供了合理的依据。
Hypothesis: Anastomotic leaks following elective colorectal resections increase morbidity, mortality, and the need for additional interventions. An accurate understanding of risk factors would potentially reduce anastomotic leaks and/or allow appropriate selection of patients for diverting stomas.Design: Prospective review of patient and operative characteristics that contribute to anastomotic leaks.Setting: Fifty-one sites within the United States (May 2002-March 2005).Patients: Six hundred seventy-two patients who participated in a trial comparing preoperative antimicrobials in elective open colorectal surgery.Main Outcome Measures: Anastomotic leaks were diagnosed using clinical findings and were confirmed with imaging. We examined 20 variables possibly affecting anastomotic healing in univariate and multivariate analyses.Results: There were 24 anastomotic leaks in 672 patients (3.6%) undergoing elective colorectal resection. There were 10 deaths (1.5%). A baseline albumin level of less than 3.5 g/dL (to convert to grams per liter, multiply by 10) (P = .04) and male sex (P = .03) were associated with anastomotic leaks in both univariate and multivariate analyses (adjusted odds ratios, 2.56 and 3.12, respectively). Increased duration of surgery (SD, 60 minutes; odds ratio, 1.53; 95% confidence interval, 1.06-2.22; P = .03) and steroid use at the time of surgery (odds ratio, 3.85; 95% confidence interval, 1.24-11.93; P = .02) were significant in univariate analysis. Surgical procedure with rectal resection; prophylaxis with ertapenem (VS cefotetan); or history of obesity, tobacco use, or diabetes was not associated with anastomotic leaks.Conclusions: Significant risk factors for anastomotic leaks include low preoperative serum albumin level, steroid use, male sex, and increased duration of surgery. Appreciation of risk factors provides a rational basis for temporary diversion.